When it comes to addiction, the never-ending search for the high is relentless. As addiction claims the user’s body and mind, everyday existence consists of thinking about using, getting the drug, using, and then thinking about using some more. Two drugs that are much in the news lately are responsible for a lot of heartache across America. One is OxyContin, a legally-prescribed Schedule II controlled substance pain medication commonly abused, while the other, black tar heroin, is an illegal Schedule I narcotic for which there is no approved medical purpose. Both are highly addictive, and both have serious side effects and long-term consequences. When black tar heroin is substituted for OxyContin, however, the results can be deadly.
Let’s take a look at each drug in more detail.
What is OxyContin?
OxyContin is a brand name for the prescription narcotic painkiller oxycodone. Oxycodone is a long-acting, strong pain reliever (opiate-type) similar to morphine and is prescribed by physicians to treat moderate to severe chronic pain (such as cancer pain). The medication is intended to be used for severe pain that is expected to last for a long time. It is not intended to be used for mild pain, for pain that will go away in a few days, or for prevention of pain following surgery.
Side Effects – Oral OxyContin has numerous side effects which may include: constipation, drowsiness, dizziness, dry mouth, headaches, increased sweating, and lightheadedness, loss of appetite, nausea, weakness, and vomiting. Some of these side effects may decrease after the patient has been using the drug for a while. Patients who experience persistent or worsening symptoms are urged to talk with their physician or pharmacist immediately. In addition, older adults may be more sensitive to the drug’s side effects – especially shallow, slow breathing and drowsiness.
Warnings – OxyContin warnings include the advice that patients who are prescribed the drug for severe pain should take it as directed by their physician and not on an as-needed basis. The drug should only be taken (60 milligram, 80 milligram, or 100 milligram tablets) by persons who already have been taking moderate to large amounts of high-strength medication such as morphine. When a person who has not been used to such potent medication begins taking OxyContin, serious and possibly fatal breathing problems (such as shallow and very slow breathing) can occur.
Oral OxyContin should be swallowed whole. Broken, crushed or chewed tablets may release large and possibly life-threatening amounts of the medication into the body.
Who Should Not Take OxyContin – Individuals with any of the following conditions should not take OxyContin:
• Taking any habit-forming drugs
• Misuse or excessive use of drugs
• Abnormal nervous system function affecting mental alertness
• Abnormal heart rhythm
• Abnormally low blood pressure
• Addison’s disease
• Asthma attack
• Bile duct tract spasm
• Brain lesion
• Chronic lung or breathing passage problem
• Enlarged prostate
• Epileptic seizure
• Gallbladder disease
• Head injury
• High pressure within the skull
• Inflammatory bowel disease
• Intense abdominal pain
• Liver problems
• Mood changes
• Narrowing of the tube that empties urine from the bladder
• Severe bloody diarrhea from antibiotics
• Significant decrease in lung function
• Slow heartbeat
• Stomach or intestinal tract operation
• Suicidal thoughts
• Toxins from microorganisms causing diarrhea
• Underactive thyroid
Withdrawal Symptoms – As with any narcotic that has been used excessively or for a long period of time, cessation of use generally causes a variety of withdrawal symptoms. Cessation of OxyContin use may produce: diarrhea, difficulty sleeping, irritability, runny nose, and stomach cramps. To prevent withdrawal symptoms in patients who have been prescribed OxyContin for severe, chronic pain, the doctor may gradually reduce the dose or change the medication.
Interactions – OxyContin may interact with other drugs or herbal products taken at the same time. Interactions may not always occur, but they can increase the risk of serious side effects or cause medications not to work properly. The following products may interact with OxyContin: cimetidine, pain medications (opiate partial agonists such as butorphanol, nalbuphine, pentazocine), and naltrexone.
The risk for serious side effects (shallow or slow breathing or severe dizziness or drowsiness) may increase if this drug is taken with other drugs or products that affect breathing or cause dizziness. This includes alcohol, anti-seizure drugs (such as phenobarbital), anxiety or sleep medication (such as alprazolam, diazepam, and zolpidem), muscle relaxants, narcotic pain relievers such as codeine, and psychiatric medications (such as amitriptyline, risperidone, thioridazine, and trazodone).
Allergy medications and cough or cold products may also contain ingredients that cause drowsiness.
Addictive Potential – OxyContin, a Schedule II controlled substance, has an abuse liability similar to morphine. It is often involved in criminal diversion. Abuse and addiction to OxyContin can occur, especially when used for non-medical purposes and/or in conjunction with other psychoactive substances. This risk increases among persons who abuse alcohol and/or other drugs, or have abused them in the past. Doctors advise that patients take the medication exactly as prescribed in an effort to minimize the potential for addiction. Patients should never give (or sell, trade or otherwise share) their prescription OxyContin to others.
Overdose can occur, which can prove fatal. Symptoms of overdose may include cold/clammy skin, slow/shallow breathing, limp or weak muscles, loss of consciousness, pinpoint pupils, severe dizziness, and severe drowsiness progressing to the point of stupor or coma, and slow heartbeat. If overdose is suspected, contact a poison control center or hospital emergency room department immediately.
Deaths due to overdose of OxyContin have been reported when the drug was abused and misused by ingesting, inhaling or injecting the crushed tablets. Risk of fatal overdose is further increased when combined with alcohol use and/or other central nervous system depressants (including other opioids).
What is Black Tar Heroin?
Heroin is an illegal Schedule I narcotic. There are different variations of heroin throughout the world, differing in quality, strength, imperfections and additives, and color. Among the various types of heroin that are popular, there are two types predominant among drug users in the United States. On the East Coast, South American “white” heroin is most popular, while on the West Coast and increasingly across the country, Mexican “black tar” heroin is the drug of choice.
Sometimes referred to as “muck,” “negro,” or “pigment,” black tar heroin has a black, sticky, hashish-like, non-powdery consistency, although it may also appear as a dark-orange or dark-brown powder, often adulterated. Black tar heroin is less expensive than white heroin, but has effects (highs) that are the same. Black tar heroin is produced primarily in Mexico. Mexican cartels and drug trafficking organizations (DTOs) are flooding the United States with black tar heroin.
Through the use of ingenious marketing campaigns where the drug peddlers come to the clients instead of vice-versa, Mexican black tar heroin has rapidly gained a foothold in this country. Black tar heroin is cheaper by far than OxyContin, whose street cost per pill can be $80, but black tar heroin is also far more deadly.
Effects of Black Tar Heroin Long-Term Use
Black tar heroin can have physiological effects in the user that are different than those of white heroin. Users of black tar heroin are also at greater risk to different disorders as a result of taking the drug.
One of the major problems facing black tar heroin users is the hardening of veins, which renders them unusable at a more rapid pace. This condition, known as venous sclerosis, may occur in persons who inject the drug intravenously. The collapse and hardening of the veins causes users to inject subcutaneously (under the skin), which causes its own problems.
Black tar heroin’s gummy consistency (tar-like) is one reason why needles clog up. This necessitates needles being thoroughly rinsed or washed between uses. Researchers recently found that this may account for why black tar heroin users have less incidence of HIV/AIDS infection than other drug users. Black tar heroin users are also less likely to share needles.
Necrotizing soft tissue infection and life-threatening bacterial infections are a risk with use of black tar heroin. Subcutaneous injection, a process known as “skin popping,” predisposes users to necrotizing fasciitis or necrotizing cellulitis, while injecting the drug deep into the muscles predisposes users to necrotizing myositis. Another risk is wound botulism, where the person’s wounds become infected with botulism.
Signs of Heroin Use
Users of heroin, including black tar heroin, may display some of the following symptoms:
• Constricted pupils
• Impaired mental functioning
• Slowed breathing
Physical symptoms occur upon cessation of black tar heroin use. Some of these symptoms include:
• Cold flashes with goose bumps
• Involuntary kicking movements
• Muscle and bone pain
Symptoms of Heroin Overdose
Heroin overdose symptoms may include the following:
• Cold, clammy skin
• Pinpoint pupils
• Shallow breathing
Use of black tar heroin in any form – injecting, inhaling, smoking or swallowing – can cause immediate harm and lead to addiction. As an illegal, Schedule I drug, heroin (including black tar heroin) is in the group of the most highly addictive drugs.
There is no safe way of ingesting heroin. Users can die from an overdose or become addicted by snorting, smoking or injecting it. Addiction can even result after the first or second use. Once addicted, black tar heroin users suffer severe cravings for the drug and are constantly in search of the next dose.
Why Users Substitute Black Tar Heroin for OxyContin
It boils down to a simple case of economics and availability. Black tar heroin offers the same – or better, some users would say – high as OxyContin, but it’s far less expensive. On the street, OxyContin goes for about $80 per pill, and users require 5 to 6 pills a day. Compare that to about $50 for a day’s worth of black tar heroin, and it’s a no-brainer.
Black tar heroin is also easier to come by for users and addicts. With the ingenious marketing and home-delivery campaign that suppliers of Mexican black tar heroin have introduced into the U.S., users can place their orders by phone and the drug is delivered to the location of their choice. No longer do users have to go to seedy parts of town, putting themselves at risk of criminal behavior (attacks by gangs, other drug users, and arrest). In addition, the new targets for the drug are white and members of the middle class. And the supply of black tar heroin to the U.S. is steadily increasing.
So, too, are the deaths. With potency far greater than in years past, today’s black tar heroin is far more addicting and dangerous than other heroin on the streets. Users, having no tolerance for the increased purity, quickly become addicted or may overdose and die.
New users, especially, seeking a quick high, have no knowledge of the potentially life-threatening consequences. Once they are addicted, they are locked into the downward drug spiral so common to long-term addiction. It isn’t that they can’t be treated, but that they often don’t wish to change their addictive behavior. For many, long-term use of black tar heroin results in massive bacterial or soft-tissue infections, wound botulism, and other complications – any of which may end in death.
Statistics Tell Only Part of the Story
The percentage and total numbers of users and/or abusers of pain relievers and heroin (which would include black tar heroin, but are not broken down as to type of heroin), are an interesting way to look at the problem. It is important to put the prevalence of these two drugs into perspective.
Heroin – According to the 2008 National Survey of Drug Use and Health (NSDUH) (http://www.oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.cfm), approximately 3.8 million Americans aged 12 or older reported trying heroin at least once during their lifetime. This represents 1.5 percent of the population aged 12 or older. NSDUH data show approximately 453,000 (0.2 percent) reported past-year usage of heroin and 213,000 (0.1 percent) reported past-month heroin use.
In 2008, 114,000 persons aged 12 or older tried heroin for the first time within the past 12 months. The average age at first use (among recent initiates aged 12 to 49) was 23.4 years in 2008.
Among students surveyed as part of the 2008 Monitoring the Future Study, 1.4 percent of 8th graders, 1.2 percent of 10th graders, and 1.3 percent of 12th graders reported lifetime use of heroin.
Pain Relievers – Prescription drugs are the most commonly abused drug after marijuana. Painkillers such as Vicodin and OxyContin are the prescription drugs most commonly abused by teens. Data from the 2008 NSDUH show that that were 2.2 million new users of pain relievers in 2008, with the average age of first nonmedical use of 21.2 years.
In 2008, the number of new nonmedical users of OxyContin aged 12 or older was 478,000, with an average age at first use of 21.8 years among those aged 12 to 49. OxyContin initiation, however, is down from 615,000 in 2004.
According to the 2008 Monitoring the Future Study, OxyContin use is higher today than it was when it was first measured in 2002. The annual prevalence rate is 2 percent for 10th grade and 5 percent each for 8th and 12th grade students. The main point, according to MTF press release material (http://www.monitoringthefuture.org/pressreleases/09drugpr.pdf), is that “these two dangerous [includes Vicodin in the reference] and highly addictive narcotic drugs remain at high levels of use among American teens.”
Availability, Price, Easy High
Both black tar heroin and OxyContin produce a relatively quick and easy high. In certain areas of the country where Mexican black tar heroin has made inroads and garnered acceptance among the population, it is easier and much cheaper to obtain than OxyContin.
Drug-seeking behavior, the motivation to search out and use the drug of choice, continues unabated regardless of whether the drug is black tar heroin or OxyContin. The main difference appears to be the potential for quicker addiction with black tar heroin and for the potentially deadly consequences of misuse, abuse, and overdose.
While the U. S. Drug Enforcement Agency (DEA) and law enforcement agencies vigilantly seek to apprehend and prosecute drug traffickers of black tar heroin, in the end, it appears that only by raising public awareness and intensifying education about the dangers of this illegal drug will have any hope of stemming the rising number of deaths.
Too cheap, too easy to come by and too potentially deadly – make Mexican black tar heroin a much more lethal substitute for OxyContin. Users, abusers and addicts of either drug should not only be made aware of the dangers, but should also seek treatment to overcome their dependence or addiction.